Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.
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Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study. / COVIDSurg Collaborative; GlobalSurg Collaborative.
in: ANAESTHESIA, Jahrgang 76, Nr. 6, 06.2021, S. 748-758.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.
AU - COVIDSurg Collaborative
AU - GlobalSurg Collaborative
AU - Betz, Christian Stephan
AU - Bewarder, Julian
AU - Bier, Johannes
AU - Böttcher, Arne
AU - Burg, Simon
AU - Busch, Chia-Jung
AU - Bußmann, Lara
AU - Gosau, Martin
AU - Heuer, Annika
AU - Izbicki, Jakob
AU - Klatte, Till Orla
AU - König, Daniela
AU - Köpke, Leon-Gordian
AU - Nitschke, Christine
AU - Praetorius, Mark Joachim
AU - Priemel, Matthias
AU - Stadlhofer, Rupert
AU - Stangenberg, Martin
AU - Uzunoglu, Faik Güntac
AU - Wittig, Lukas
AU - Zech, Henrike Barbara
AU - Zeller, Nina
N1 - © 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.
PY - 2021/6
Y1 - 2021/6
N2 - Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
AB - Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
KW - Adolescent
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - COVID-19
KW - Child
KW - Child, Preschool
KW - Cohort Studies
KW - Female
KW - Humans
KW - Infant
KW - Internationality
KW - Male
KW - Middle Aged
KW - Practice Guidelines as Topic
KW - Prospective Studies
KW - SARS-CoV-2
KW - Surgical Procedures, Operative/statistics & numerical data
KW - Time
KW - Young Adult
UR - https://doi.org/10.1111/anae.15458
U2 - 10.1111/anae.15458
DO - 10.1111/anae.15458
M3 - SCORING: Journal article
C2 - 33690889
VL - 76
SP - 748
EP - 758
JO - ANAESTHESIA
JF - ANAESTHESIA
SN - 0003-2409
IS - 6
ER -